How to use CAMS with safety and confidence

Complementary medicines and nutritional supplements aim to enhance physiological function in the body, assist in the prevention of disease and stimulate the innate healing potential of the body.

Although complementary medicines generally have positive effects, it is essential to emphasise that ‘natural' does not necessarily or automatically mean ‘safe' and ‘without harmful side effects'. It is also important to ascertain that what is in the bottle is safe to take and that the product does what it claims.

Complementary medicines have pharmacological properties - as do conventional pharmaceuticals. It is therefore possible for adverse reactions to occur between, for example, a herbal medicine and a pharmaceutical or some other prescribed or over-the-counter product.

Complementary medicines can however be a valuable support to conventional treatments for chronic conditions such as heart disease and certain types of cancer. The herbal medicine repertoire includes tonics that help support heart function while some complementary medicines ease the discomfort of cancer treatments.

One needs to be aware that what's in the bottle might not always match what's on the label. For example, a supplement might not contain the correct plant species ingredient. One US study analysed 59 preparations of Echinacea and found that about half did not contain the species listed on the label. A supplement might also contain higher or lower amounts of the active ingredient. An NCCAM-funded study of ginseng products found that most contained less than half the amount of ginseng listed on the labels.

General precautions

• Always chose quality products to ensure safety and efficacy. Contact the HPA if unsure of the quality and integrity of a product range.
• Prescription medication should not be discontinued, nor should the dosage be altered without the advice and monitoring of a health care practitioner.
• Be aware of the possibility of drug interactions between complementary products themselves, as well as between complementary and pharmaceutical products - regardless of whether they are available on prescription or over-the-counter.
• Hypersensitivity to the ingredients or components of any medicines contraindicates its use.
• Do not keep or use outdated medicines. Look for the Use By date on labels and respect it.
• When self-medicating, consult your practitioner if symptoms worsen or if an acute condition does not improve within three days.
• Do not exceed the recommended dose of a supplement or remedy unless advised to do so by a health care practitioner.
• Side effects refer only to those which occur at the recommended dosage and correct route of administration.
• If side effects occur, stop taking the supplement or medicine and contact a health care professional.
• If in doubt or when further information is required, consult the current package insert or the relevant manufacturer or distributor.
• Appropriate storage criteria need to be observed when storing complementary medicines: store out of sunlight in a cool, dry place and in a well-sealed container.
• Should surgical intervention be required, advise your health care practitioner of your complementary medicine use.
• Certain medicines (those that cause CNS depression) may lead to drowsiness and impaired concentration and this may be aggravated by the simultaneous intake of alcohol or other central nervous system depressant agents.
• Medicines should not be prescribed for, or dispensed to, pregnant or lactating women where a product is not specifically formulated for use in pregnancy or during lactation. Although many complementary medicines are safe to use during pregnancy, it is advisable to proceed with caution and consult a health care practitioner.
• Where dosage recommendations for any product are not specified for children, consumers and health care professionals must be aware that this may indicate that safety and efficacy have not been formally established in children, although there may be some clinical experience available for the particular age group.
• In the case of diabetics, caution must be exercised with complementary medicines containing sugar.
• Renal and liver dysfunction of any severity may increase plasma concentrations and prolong the action of many medicines eliminated mainly by these routes and may therefore increase the risk of side effects.
• Immune-compromised patients with chronic conditions such as HIV/AIDS or cancer are advised to consult their health care practitioner before taking complementary medicines.
• Tolerance to medicines is likely to be less with extremes of age.

Possible side effects
Certain complementary medicines could cause side effects. For example:

• St John's Wort may cause gastrointestinal disturbances, allergic reactions, fatigue, vertigo, dizziness, confusion, dry mouth, photosensitivity.
• Ginkgo biloba can cause bleeding.
• Ephedra (ma huang) could result in hypertension, arrhythmia, anxiety, nervousness, insomnia, tremor, headaches, seizure, cerebrovascular events, myocardial infarction, kidney stones.
• Kava may cause sedation, oral and lingual dyskinesia, torticollis, oculogyric crisis, exacerbation of Parkinson's disease, rash.

Possible drug interactions with herbal products

• St John's Wort can increase the effects of prescription drugs used to treat depression. It can also interfere with drugs used to treat HIV infection, cancer and for birth control as well as drugs used to prevent the body from rejecting transplanted organs.
• Ginseng can increase the stimulant effects of caffeine. It can also lower blood sugar levels, creating problems when used with diabetic drugs as well as have an adverse reaction with blood thinning medications like Warfarin.
• Ginkgo, taken with anticoagulant or antiplatelet drugs, can increase the risk of bleeding. It is also possible that ginkgo might interact with certain psychiatric drugs and with some drugs that affect blood sugar levels.

CAM and Surgery
Usage of CAM, including herbals, homeopathic remedies and supplements, must be disclosed and recorded prior to surgery. Non-disclosure of the use of CAM can cause a potentially dangerous situation in the peri-operative period. As certain supplements may increase the risk of bleeding or affect anaesthetics and painkillers, it is best to stop all formulations pre-operatively and re-start them after discharge.
Supplements vital to discontinue include:

• Arnica - there is concern regarding intra-op bleeding.
• Echinicea - because of potential allergic reactions and because it may cross-react with immuno-suppressives.
• Garlic - there is concern regarding post-op bleeding as a result of its antiplatelet effect.
• St John's Wort - for it potential multiple drug reactions.
• Ginkgo biloba - for its antiplatelet effect and vasodilation.
• Kava - because of sedative effects.

REFERENCES MIMS Complementary Desk Reference MediCAMS Index National Center for Complementary and Alternative Medicine - http://nccam.nih.gov/